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Infertility isn’t just a woman’s problem. Men can be infertile too. About one-third of infertility cases can be attributed to female infertility while men’s problems account for another third of infertility cases. The remaining third of cases may be caused by a combination of male and female infertility, and in ten percent cases there may not be known cause.
Considering the fact that female’s infertility stems from problems with ovulation in many cases, ovulation induction is that beacon of hope which bears the possibility of you getting on to the much awaited, brand new chapter of your life, parenthood.
Maybe it’s been a while you have been trying to conceive but there’s been no luck or maybe your age clock is ticking or it could be certain conditions like PCOS, sexual dysfunction or issues related to both of you standing as a formidable obstacle in the delightful path of becoming parents.
Whatever it is, worry not there are multiple options and treatments available to help you fight away the woes of fertility issues.
Ovulation induction is quite successful and is usually the first line of treatment of Assisted Reproductive Treatment (ART) to help conceive.
WHAT IS ART (ASSISTED REPRODUCTIVE TREATMENT)?
In ART women are given various injections for further maturation and development of eggs. Multiple eggs are retrieved from the woman and these eggs are fertilised with sperm obtained from the man externally in the laboratory. After fertilization the embryos are obtained and then they are returned to the women’s uterus. This is in-vitro fertilisation (IVF) which is a laborious process but has proven to be quite successful and the baby born through IVF is called test tube baby.
Ovulation induction is the first step and an important aspect of ART.
WHAT IS OVULATION INDUCTION?
Let’s start by understanding the basics first.
Ovulation is the process where a mature egg is released by the ovary in each menstrual cycle (each month) for it to be fertilised. As described in the figure above, the first day of the period is considered as day 1 of the monthly menstrual cycle and last day of the menstrual cycle is a day before from the beginning of your next period. Ovulation occurs midway of the menstrual cycle usually on the 14th day of the cycle where the cycle is of 28 days. Ovulation occurs once in every monthly period (once in every 28 days, though once in 21-35 days is acceptable depending upon the period length).
Anovulation is an infertility condition which occurs when maturation of eggs and release of the eggs from ovaries fail. In some women though they have regular monthly periods (menstrual cycles) but mature eggs are not released from the ovaries and these women suffer from infertility.
Ovulation Induction is the process of stimulating ovulation in women having irregular or absent ovulation (anovulation) through medications.
ARE YOU A CANDIDATE FOR OVULATION INDUCTION?
You are a suitable candidate for the treatment of ovulation induction:
Ovulation induction can also work in conjunction with IVF (in-vitro fertilisation) stimulating multiple eggs to mature and get released which are then collected and fertilised externally in the lab.
OVULATION INDUCTION MEDICATION:
You need a doctor’s consultation and proper diagnosis before starting with the ovulation induction treatment. In some cases, like obesity or thyroid disorder, treating these first sometimes spontaneously initiates ovulation.
Ovulation induction medications are available in two types- oral and injectable.
Oral Ovulation Induction Medication:
Oral ovulation medication is the first line of treatment in women who do not ovulate or who ovulate infrequently. Oral ovulation induction medicine is easily available, has lesser risks (compared to injectable) and is easy to administer.
Clomiphene citrate: Clomiphene citrate is the oral medication prescribed for the ovulation induction. Clomiphene is also used to treat absent or irregular menstrual cycles. It blocks the estrogen receptors in the body and tricks the brain into increased hormone production which leads to the development of one or more follicles (sacs containing eggs) in the ovary. Multiple follicles will release multiple mature eggs (ovulation).
Aromatase inhibitors: Popular example is Letrozole which is given for patients with similar indications as Clomiphene citrate, that is, for irregular or absent ovulation. This is usually given if the patient develops side effects for Clomiphene citrate.
Insulin-sensitising agent: This is usually given for patients with PCOS who show evidence for diabetes. Popularly the medicine is known as Metformin. Metformin may be used to induce ovulation by itself or in combination with clomiphene (CC) or letrozole. The other important insulin sensitising agent is myoinositol.
Injectable Ovulation Induction Medication:
These are chosen for the treatment if oral medications are unsuccessful. The fertility doctors and nurses will help you learn how to inject as they are to be taken daily and are easy to inject.
Gonadotropins: This consists of injectable hormones-gonadotropins. Generally, given for 7-10 days daily but it may vary depending on the kind of protocol decided by your doctor. As the gonadotrophins are much more powerful than oral medications, they require more frequent monitoring (ultrasound and blood tests). These gonadotropins are given to produce multiple eggs which is known as hyperstimulation. It is controlled hyperstimulation as it is regularly monitored with ultrasounds and blood hormone level tests. Gonadotropin doses are modified depending upon the response. This is a crucial step of ART (Assisted Reproductive Treatment) or IVF (in-vitro fertilisation)
HCG (Human Chorionic Gonadotrophin): It is injected when the eggs are mature in the ovary and helps in egg release and retrieval. Post this injection the couples are either advised for sexual relation or the female can undergo intrauterine insemination (iui) (placing millions of sperms near the uterus through artificial method). In some women the multiple eggs are collected for in vitro fertilisation/IVF.
Again, it is essential to keep in mind that a doctor’s consultation, diagnosis and frequent tests throughout the cycle are of utmost importance for increasing the success and reducing the risks of ovulation induction.
OVULATION INDUCTION TECHNIQUE:
The ovulation induction technique consists of four major steps which have been described below. The sequence and duration of each step depends on the protocol identified by your doctor.
1.ASSESSMENT: The doctor will assess your ovulation cycle with blood tests to evaluate your hormone levels and ultrasounds to check for the development of follicles in the ovaries and also to check the thickness of the lining of the womb.
2.STIMULATION: The doctor with the help of medication stimulates and promotes the growth of follicles/sacs containing eggs in your ovaries. The type, dosage and combination of medicines depend on the assessment of your case and the protocol decided by the doctor.
3.MONITORING: The number and size of follicles developing is monitored very closely throughout the cycle in order to reduce the risk of multiple pregnancies.
4.TIMED INTERCOURSE OR ARTIFICIAL INSEMINATION: Near the time of your ovulation, the doctor will advise the most appropriate day to have sexual relation or perform Intra-Uterine Insemination where prepared sperm (from your partner/donor) are inserted into the womb.
RISKS OF OVULATION INDUCTION:
Ovulation induction success rate is good and mainly depends on the diagnosis, age and other factors like PCOS, diabetes etc. If ovulation induction doesn’t work out for you, still options like surrogacy and adoption are available.
Coping with infertility and dealing with its treatment requires patience, a trusted doctor’s guidance and lots of positivity. All along the treatment make sure to take a healthy diet, exercise and to be in touch with a psychological counsellor for sound advice. All these together will help you fight away the woes of infertility in the best way possible and help in conceiving.